Hey. I saw in another post (by MG) that "if there is greater than a 10% difference you may have a side order of adrenal issues." I find this interesting as mine have always been at least that much off:
Note: Every single one of these were taken on 75mcg of Levothyroxine. I had the tests done between 8 and 8:30, before my meds. I take Calcium and Iron 8-12 hours later, and eat at least 1 hour later. My Cortisol has been checked twice:
8 am-31.7 (5-25)
My endo said that these are artifically elevated because I am taking BCP which contain Estrogen, which binds with your Cortisol Binding Globulin, and shows the Cortisol as high. And if I were to stop BCP, my Cortisol would be perfectly normal, so I can't have an adrenal problem. Also, my DHEA-S (9/24/07) was 22 (145-395). I was told by an endo that there is no such thing as DHEA-S being too low, and that they only worry when it's too high. I asked, well if it can't be too low, then why is there a bottom end of the range. They just ignored me as though I hadn't even spoken. Help anyone? If you need any other blood tests, I've probably had it done....
I felt my ears and fingers itching.. so I knew someone was typing about me.
Well going off the BCs for 2 months and getting retested might be what you need to do. I was taken off of them because of heart and increased spinal fluid issues. Thus the only supplement in my system at the time that could bias my results was my 20 mg of DHEA sulfate.
Your FT3 is lower than the FT4. This can be due to adrenals OR due to improper T4 to T3 conversion. have you had your rT3 levels checked. Your FT4 level and FT3 levels are sub optimal. Especially give the T3 supplement. If your MD refuses to up you more in both you are going to continue to feel worse. Either way you are under medicated right now, being in your 20's and having a T4 in the 31% range. I am remember my facts right: Nursing student, young, in college? The TSH range does not correspond to the level of T4 in your system, this is a definite sign of TSH suppression. You should be below optimal range and be looking at the levels of your FTs. I went into detail on TSH suppression in my Care and Concerns - week 2 post. Go check that out if you haven't already.
Other companion tests to the cortisol are ACTH and aldosterone. Have they tested your ACTH? This is a fasting blood serum test that is not effected by BCs and should be drawn at 8 am. If an ACTH has not been run, here is what my non-MD experience recommends:
I would recommend an ACTH being drawn as well as a total T series (TT3, TT4, T3 Uptake, and rT3). To see where you stand there. If it is high cortisol suppressing the T3 synthesis in the liver and your pituitary gland is functioning normally. The ACTH will be high to correspond to the cortisol being high. Also add a saliva cortisol test to see where you are throughout a day. Look into the symptoms of Cushing's as well as Addison's and compare with adrenal fatigue. See which closest matches your symptom data set.
It may be simple and your RT3 comes back high and they put you on Armour or cytomel to fix the T3 deficiency. In the mean time take an OTC DHEA sulfate supplement. The max you want is 20 mg.. try 10 mg first. You are too low not to be taking any. I am not an MD so call and ask your MD is taking 20 mg/10 mg of DHEA will hurt you. If they say no. Take it, it may just help some. I was low in DHEA and cortisol and high in ACTH. This corresponds to adrenal insufficiency. My pituitary is screaming at my adrenals to get back to work and my adrenals are lying in a lawn chair giving it the finger. Visual imagery of my body parts being crude to other body parts helps me stay amused. Yes I am Hashimoto's and looney. I will spare you the visual imagery I imagine my thyroid tissue under siege illicits.
For adrenal insufficiency I am taking: DHEA, Omega(Fish oil with DHA and EPA), and Cortisol. I replace with 4 - 5mg tablets spaced out throughout the day. DHEA is taken in the morning 10 - 20 mg. If bad acne starts and stays after 6 weeks on the supplement, back off in 5 mg increments with 6 week test periods in between. So far 20 mg of DHEA is working for me. It will not interfere with thyroid meds.
I hope you find you answers soon. I will be curious what future adrenal blood work will show.
If we learn by our mistakes, I am working on one hell of an education.
Hey. Thanks for the response, and sorry for making you burn up .
I would have no problem going off the BCP for 2 months so that a lot of blood work (androgens, cortisol, etc) could be done, except for the fact that every time I stop for even 1 month I end up in the hospital because my cramps are so bad. And we're talking, close to passing out. When me dislocating my wrist registers as, oh ok. My pain tolerance is insanely high, but the cramps do it to me. So if it weren't for that, I would already be off them.
rT3 has not been checked. My current endo doesn't believe in even checking any form of T3 and T4. I even tried to point out to her that they have both been steadily dropping for the last few months. Response? Well, that doesn't matter because you have the best TSH you've ever had. And refused to increase my T4 from 75 to 88 since it might push my hyper, put gave my 5mcg T3 since I feel so bad. I wonder what she's going to say to the suppressed TSH now....?
I went and checked out the Week 2 post, but still have a few questions. My TSH before has always corresponded appropriately with my FT3/FT4. TSH 7.88/ FT4 1 (25%). For the last like 5 years. Hypo, but blood work all lined up. I've been on the BCP for close to 3 years now, added no new medications recently. What on earth is going on here? And to make things even worse, I just got put on Advair 250/20 and Albuterol for the asthma, both of which are glucocorticoids, which I saw in the Week 2 post can artificially suppress your TSH...Ain't I a wonderful mess?
I've had most blood work done, but it was like pulling teeth to even get the Cortisol retested. Took 3 GP's (student health center) and 2 endo's before I finally got it. I'm back home with my original endo now though (didn't try with her as was out of state), but she's the one that said there's no way I have an adrenal problem.
*Whew* I should be hearing from my endo soon as I had some blood work done 2 weeks ago (Vit D, androgens), and will talk to her then. Since starting on the T3 (5mcg), I actually feel worse than before taking it. Is this possible? Or is this some kind of clue that might point to what's going on? And I haven't had any blood work done since starting it, so that isn't any help.
Have you ever had your magnesium levels checked? I know it is the "calming" mineral, and I was thinking of your severe menstrual cramps AND your new-onset asthma. I believe (if I can trust my nonworking brain!) I remember that they use mg++ to treat cases of asthma, so maybe you're low?????
So....the endo's nurse just called me this morning to say that all of my blood work was "good." Only checked Vit D (which was fine 4 months ago) and androgens, so I expected it to be. However, I told the nurse that I actually feel worse since I started the Cytomel, and now what? She went back and spoke with the endo, and then told me to stop taking it entirely and go see a rheumatologist to be checked for fibromyalgia and chronic fatigue syndrome.....when will this ever end? All I want is to feel good enough that I don't have to keep taking a medical leave from college every 6 months....
Have you tried an integrative medicine internist? I would look for one. They would be more open to working with you and more accessable as well. It is who I am using. I am looking into Endos elsewhere. Do you think each state has at least one capable of healing us? I would just settle for competent thorough practice.
If we learn by our mistakes, I am working on one hell of an education.
I just made another post asking if anyone knew of a good doc in my area--around Charlotte, NC right now, and willing to travel. I had really been hoping this lady would be the one though as she specializes in thyroid disorders. *sigh*....you would think there would be at least 1 person that could treat us....I agree with what someone else said. How about you go be a doc and treat all of us?